Adaptation to New Dentures and 5 Years of Clinical Use: A Comparison between Complete Denture and Mini-implant Mandibular Overdenture Patients based on Oral Health-Related Quality of Life (OHRQoL) and Orofacial Esthetics.

Objective of work: It is unclear how long patients need to adapt to new dentures. This study assessed adaptation and five years of clinical use, comparing complete denture wearers (CDs) and mini-implant mandibular overdenture wearers opposing a maxillary CD (MDI-OD), based on oral health reported quality of life (OHRQoL) and orofacial esthetics (OES). Material and Methods: A total of 36 subjects in the CD group (25 females) and 30 subjects in the MDI group (20 females) completed the 5-year study. All patients received new CDs, but in the MDI-OD group, four mini-implants were inserted interforaminally in the mandible before denture manufacture. Participants filled in the OHIP-EDENT and OES questionnaires one day after dentures' delivery, on the 3rd, 8th, 15th, 30th day, and at the 1-, 3- and 5-year follow-up examinations. Statistical analysis comprised descriptive methods, X 2 test, independent t-test, Friedman, and Mann-Whitney test. Results and Conclusions: Both groups' adaptation to new dentures was completed within a month. The MDI-OD group had significantly better OHRQoL in all follow-ups except for the 3rd and 8th day, probably due to soreness and pain, the reason why the MDI-OD group had limitation in functioning in the first days after new dentures' delivery. Already after the third year and at the fifth year, OHRQoL worsened (p<0.01) in both groups. However it was significantly more pronounced in the conventional CD wearers (p<0.01) than in the MDI-OD group. Orofacial esthetics was highly scored in both groups. The scores dropped down only after three years, equally in both groups. Keywords: OHRQoL, OES, prospective study, complete dentures, mini-implants, adaptation. MeSH Terms: Complete Dentures; Dental Implants; Quality of Life; Dental Esthetics.

Oral Hygiene Practices and Oral Health Knowledge among Students in Split, Croatia.

BACKGROUND: Knowledge of oral health is a fundamental prerequisite for healthy behavior, allowing individuals to take measures to protect their overall health. This cross-sectional study aimed to examine the knowledge of oral health as well as to assess the oral hygiene habits among healthcare and non-healthcare students. METHODS: The study was based on a questionnaire and was conducted among 1088 students. Most of the students, 67.6% were non-healthcare students. Data were processed by Mann-Whitney or Kruskal-Wallis one-way ANOVA test. RESULTS: The correct median score and interquartile range were 11 (9-13) for all surveyed students, 11 (9-12) for students in non-healthcare programs and 13 (11-14) for students in healthcare programs. Students did not significantly differ in the knowledge of oral health by gender (p = 0.082) but did differ by age, study program, and year of study (p ≤ 0.001). Students whose family members work in the field of dental medicine also showed better oral health knowledge (p ≤ 0.001). CONCLUSION: The results showed good oral health knowledge among tested university students. However, it is important to emphasize that students who showed better knowledge more often used additional aids to maintain oral hygiene; therefore, the obtained data underline the importance of students' further education in order to better understand and maintain oral health.

Comparison of different surgical procedures on the stability of dental implants in posterior maxilla: A randomized clinical study.

BACKGROUND: Stability of a dental implant is very important when planning immediate loading and design of a final restoration. The aim of this study was to compare the primary and the secondary stability of dental implants inserted by three different surgical techniques: conventional (standard) technique using a sequence of drills for implant bed preparation, osteotome technique using tapered hand instruments for creating implant sites by condensing the bone and guided flapless implant surgery with surgical templates. MATERIAL AND METHODS: The study included 150 patients (80 males and 70 females), 46-71 years old, who required implant supported fixed partial dentures in the posterior maxilla of D3 or D4 bone density. Patients were randomly assigned into one of the three surgical insertion technique groups. All patients received tapered implants of the same manufacturer of the same length and two different widths (3.3 × 11.5 mm or 4.2 × 11.5 mm). Primary and secondary implant stability were measured by means of resonance frequency analysis (RFA) at the time of implant placement and 5 months after surgery using the Ostell ISQ device (Osstell AB, Sampgatan, Goteborg, Sweden). Statistical analysis included one-sample Kolmogorov Smirnov test, descriptive statistics, multivariate analysis (Bonferoni post-hoc tests) and paired t-tests. RESULTS: Patients in the osteotome group exhibited higher primary stability (P < 0.01) than in the conventional and surgically guided flapless groups. There were no significant differences in the secondary stability (p > 0.05). Wider implants presented higher ISQ values (P<0.01). CONCLUSION: The osteotome technique led to the highest implant primary stability, therefore it can be recommended when immediate loading is planned or for one-piece implant insertion.

Course and rate of post-fracture bone healing in correlation with bone-specific alkaline phosphatase and bone callus formation.

Alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (S-bone ALP) activities may serve as markers of the course and rate of bone healing after sustained fractures. The aim of this study was to examine whether the assessment of S-bone ALP as a biochemical parameter in the early posttraumatic phase may indicate the course of fracture healing. To date, the methods used to monitor the bone healing process have been based on the patients' assessment and the radiographic findings. In view of the fact that patient opinion is highly subjective, that the radiographic findings depend on the radiologist's experience and that the monitoring of bone healing is a long-lasting process, measurements of biochemical parameters appear to be the only objective evidence of the changes occurring during bone regeneration. In this study, the activity of bone-specific alkaline phosphatase was measured in the serum of 41 patients who had sustained long bone fractures. The participants included 26 males and 15 females, aged 15 to 80 years. All patients were treated surgically. The activity of S-bone ALP was assessed every seven days over a period of 4 weeks. The study patients were followed up radiologically for several months. Our research showed that the increase of alkaline phosphatase correlated with an increase of S-bone ALP levels. In addition, changes in ALP levels on days 7 and 14 as compared to those on day 1 post injury were associated with changes in S-bone ALP levels on the same day. Likewise, the callus volume correlated with the decrease, no change or increase in the levels of ALP and S-bone ALP in the same way. Based on these results, it may be concluded that monitoring changes in the biochemical parameters alkaline phosphatase and bone-specific alkaline phosphatase allows early detection of fracture healing rates. A minor increase in the activity or no change in the level of the biochemical parameters ALP and S-bone ALP in the period of the first two weeks indicates successful fracture fixation, rapid bone healing and the formation of a minimal or insignificant callus. A major increase in the activity of the biochemical parameters ALP and S-bone ALP in the period of the first two weeks indicates inadequate fracture fixation, delayed bone healing and the formation of a visible and significant callus.

Colour discrimination of dental professionals and colour deficient laypersons.

OBJECTIVES: The aim of the present study was to compare results of non-dental (conventional) and dental colour discrimination tests (customized, shade guide test), to evaluate influence of profession, gender and age of colour normal dentists and laboratory technicians on colour discrimination results and to evaluate results of colour deficient laypersons. METHODS: A total of 36 colour normal dental professionals, all volunteers were divided into two groups consisting of 18 participants each: dentists (DDS) and laboratory technicians (CDT). In addition, a group 15 colour deficient males also volunteered (CDP). Colour discrimination was examined using Farnsworth-Munsell 100 Hue Test and total error scores (TES) were calculated. Participants performed a dentistry related colour discrimination test by matching 26 pairs of shade tabs. Shade guide scores (3DS) were calculated. These tests were performed under the controlled conditions of a viewing booth. Mean values and standard deviations were determined. ANOVA, Mann-Whitney test, t-test and Pearson's correlation coefficient (r) were used for result analysis. RESULTS: TES and 3DS were correlated for colour normal observers, r = 0.47 (p < 0.01). No statistically significant differences in TES and 3DS by profession, gender and age were recorded. TES of 159 (83) and 3DS of 6.7 (2.7) were recorded for colour deficient laypersons. Based on TES, 33% of colour deficient laypersons had average discrimination, whilst 67% had low discrimination. CONCLUSIONS: Within the limitation of this study, it was concluded that results of non-dental and dental colour discrimination tests were correlated, and that profession (DDS/CDT), gender and age gender did not influence colour discrimination of colour normal participants. CLINICAL SIGNIFICANCE: Although colour and appearance of dental restorations are of paramount importance for the aesthetic outcome, colour vision of dental professionals is not routinely tested. This paper validates and recommends the usage of dental shade guides for a simple, affordable and understandable testing of colour vision, either as a sole test or complementing conventional (professional) tests.

Our experience with modified osteomyoplasty for reamputation of war-related transtibial amputees.

The aim of this study was to examine the efficacy of the operative method of modified osteomyoplasty in relation to primary "guillotine" amputation in Croatian war amputees. From 1995 to 2000 a total of 425 patients underwent transtibial amputation for their war-related injuries. From these group, 52 patients were selected that were unable to tolerate prosthetic wear. Following primary amputation, these 52 patients underwent reamputation surgery using the technique of modified osteomyoplasty. The efficacy of the operative method was assessed in relation to age, presence of complications before amputation, the level of amputation, the number of amputations, motivation for social integration, and the normalization of physical activity and the patient's level of satisfaction (graded from 1, unsatisfactory to 5, completely satisfactory). The results of the analysis showed that the application of modified osteomyoplasty as the method of choice for transtibial residual limb reconstruction creates the basic prerequisite for functional prosthetic fitting. The level of satisfaction significantly increased from the mean value of 1.21 before the surgery to the mean of 2.96 one year after the surgery (Z = -6.270, p < 0.001, Wilcoxon signed rank test).

Prognostic significance of BsALP in healing of long bone fractures.

The aim of this work was to assess the relationship of both total alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (BsALP) with the course and outcome of operatively treated long-bone fractures. The activity of total ALP and BsALP was measured in 41 patients with a long bone fracture, comprising 26 men and 15 women. All patients were treated operatively. Total ALP and BsALP levels were measured in sera on day 1, 7, 14 and 21 after sustaining injury. Patient monitoring included X-rays. According to the outcome, patients were divided into two groups: the fast healing group and the slow healing group. The levels of total ALP and BsALP showed parallel trends in the course of this study. Depending on the healing outcome, on day 7 an increase in the case of slow healing, or a decrease in the case of fast healing, for both BsALP and total ALP was observed. No difference was found between various sites of bone fracture. This is an important result indicating the prognostic significance of total ALP and BsALP measurement in the monitoring of long bone fracture healing. In addition, an early change in the level of these enzymes was associated with the efficiency of the performed surgery.

Denture repairs in different regions of Croatia in relation to prosthodontic teams.

The purpose of this paper is to evaluate the incidence of denture repairs in different districts of Croatia through the year of 2002. and to analyse the percentage of different repairs (relinings, simple repairs up to 2 elements and complicated repairs-more than 2 elements) in relation to prosthodontic teams. Data on the number of dentures, and the number and types of denture repairs delivered in the Croatian regions of Zagreb, Rijeka, Split and Karlovac were obtained from the Croatian Institute for Health Insurance for the whole of the year 2002. Information of the number of prosthodontic teams operating in those regions was also obtained. Proportionally more denture repairs were carried out in Karlovac (18%) than Split (5%). The smallest percantage of dentures that required relining was registered in Split and the highest in Rijeka (chi2 = 36.7, p < 0.01). The smallest percentage of simple repairs was registered in Rijeka and the highest in Split (chi2 = 24.3, p < 0.01). The smallest percentage of complicated repairs was registered in Split and the highest in Karlovac. In each region the proportion of denture repairs and types of repairs were correlated with a number of prosthodontic teams in that region. Karlovac had the smallest percentage of specialistic prosthodontic teams and the highest rate of denture repairs.

Epidemiological study on removable denture deliveries in different districts of Croatia, 1996-2001 and 2002.

Aim of this study was to determine the prevalence of removable denture (complete and partial) deliveries through Croatian Public Health Service (covered by insurance) in different districts of Croatia and to compare the two periods: 1996 to 2001 and 2002. Number of dentures delivered was obtained from Croatian Institute for Health Insurance for the district of Zagreb, Rijeka, Split and Karlovac. Information of the population living in the same districts was obtained from the National Institute for Statistics. The percentage of fully edentulous inhabitants varied from more than 13% to more than 20%, dependent on the district, while the percentage of partial edentulism reconstructed with removable partial dentures varied from more than 13% to more than 30%. The highest percentage (average for living population) of complete and removable partial dentures was delivered in Zagreb in the both observed periods. In all districts, the number of complete denture wearers increased in 2002, except in Split. The percentage of removable partial denture deliveries increased significantly in all examined districts. Partial and complete denture deliveries increased in higher percentage in population younger than 70 years than in older population. The percentage of metal framework removable partial dentures increased significantly in all districts. The prevalence of removable denture deliveries increased, especially in patients younger than 70 years. This was attributed not only to the consequences of the 1991-1995 war, the migrations from rural to urban areas, decrease of economic status, but also to the new rules of the Croatian Insurance System.

The amputees and quality of life.

The application of highly sophisticated computer technology and high technology materials allows production of quality prosthetic replacements both in the functional and esthetic sense. The basic prerequisite for successful use of prostheses is an adequately shaped stump, which can be achieved using new operative technique used for extremity amputation. In this way, the possibilities of prosthetic device usage are enlarged to fulfill not only basic daily needs but also highly active work-related, sports-related or recreational needs of the modern man. However, the adequate and successfully performed operative procedure and the implementation of a quality prosthetic device do not guarantee that all patient requirements for improved quality of life are fulfilled. The aim of this study was to examine therapeutic effects of the applied method of surgical and prosthetic treatment, with a special focus on the improvement of patient's quality of life. The research was conducted in a sample of healthy and active patients with trauma-related lower extremity amputation. Following a positive objective evaluation by the physician, who stated that surgical and prosthetic treatment was satisfactory, the subjective evaluation was performed by the patient using a specially designed questionnaire. The factors possibly influencing the overall satisfaction of the patient with therapy were analyzed. The satisfaction with prosthesis function was evaluated as very good by 63.5% of the patients, excellent by 9.6% and good by 26.9% of the patients.

Patients' satisfaction with prosthetic devices.

The purpose of the paper was to ascertain the factors which affect the satisfaction of patients with the prosthetic therapy. The purpose of the paper was also to ascertain if there are common factors characteristic for patients dissatisfied with the prosthetic therapy although the specialist appraises it as objectively successful. 52 patients of the Clinical Institute for Rehabilitation and Orthopedic Devices were participating in the research, to which, after unsuccessful surgical-prosthetic rehabilitation, reamputation and prosthetic provision was carried out, which was appraised successful by the doctor. It was endeavored to appraise to what extent the appraisal by the doctor corresponds to patient's satisfaction. On the basis of the questionnaire elaborated specifically for this research and the statistical processing, it was concluded that where the doctor appraised the prosthetic therapy as successful, the same opinion was shared by the majority of the patients (92.3%). Patients are similarly satisfied with the function and the esthetic quality of the prosthesis (73%). The reason why 7.7% of patients are dissatisfied in cases when the doctor considers that there are no objective reasons for that should be sought in non-medical factors. The age, the education, the marital status, the income state, the size of the residence and the regional affiliation do not have a significant influence on the satisfaction of patients with the prosthesis (p > 0.05). Patients with a minor handicap achieve satisfaction with the prosthetic therapy faster, as well as the right-handed persons if the prosthesis on the right-hand extremity is in question (p < 0.05). This investigation showed that the responsibility of not wearing prosthetic aids, both orthopedic, and dental prostheses, couldn't be only neuroticism by prosthetic patients, because that connection is not statistically significant (p < 0.09).